Association of dynamic changes in platelet-to-lymphocyte ratio during chemotherapy with survival in patients with non-small cell lung cancer
- 1Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University , ,
- 2Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University , ,
Abstract
Background: Inflammatory markers have been reported to be associated with outcomes in non-small cell lung cancer (NSCLC). However, whether early treatment-related changes in these markers provide additional prognostic information remains unclear. This study evaluated the association between dynamic changes in peripheral blood inflammatory markers during chemotherapy and survival outcomes in patients with NSCLC.
Methods: We retrospectively analyzed 479 patients with NSCLC who received chemotherapy. Changes in lymphocyte, platelet, and neutrophil counts, as well as the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR), were calculated as absolute differences (D-values) between baseline measurements obtained before the first chemotherapy session and post-chemotherapy measurements obtained within 7 days after the first session. Overall survival (OS) was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Additional Cox models were used to examine the association of PLR D-value with OS after accounting for baseline PLR and clinical covariates. A prognostic nomogram was constructed as an exploratory risk-estimation model.
Results: Greater changes in the evaluated hematological markers were associated with shorter OS in Kaplan–Meier analysis. In the primary multivariable Cox regression, high PLR D-value was associated with shorter OS (hazard ratio, 1.422; 95% confidence interval, 1.001–2.020; P = 0.049), together with sex, anemia status, and tumor extent. After adjustment for baseline PLR and clinical covariates, however, PLR D-value was no longer significantly associated with OS when analyzed either as a continuous variable (HR per 50-unit increase, 1.010; 95% CI, 0.947–1.078; P = 0.762) or using the original high/low classification (HR, 1.31; 95% CI, 0.91–1.89; P = 0.145). The nomogram had an apparent C-index of 0.630 and an optimism-corrected C-index of 0.618 after 1,000 bootstrap resamples.
Conclusions: Greater changes in PLR during chemotherapy were associated with shorter OS in the primary categorical analysis. However, this association was attenuated after baseline PLR and clinical factors were taken into account, indicating that the additional prognostic contribution of PLR D-value may be limited. The nomogram should be considered exploratory and requires external validation before clinical application.
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BibTeX
@article{xu2026association,
title = {{Association of dynamic changes in platelet-to-lymphocyte ratio during chemotherapy with survival in patients with non-small cell lung cancer}},
author = {Tingshan Xu and Zihang Wu and Jingshan Li and Lingxuan Wang and Baoqiang Weng and Luyang Chen and Xiaohui Chen and Qingyuan Zhu and Peng Liu and Fei He and Yuan Xu},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1934583},
url = {https://europepmc.org/article/PMC/PMC13672012},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of dynamic changes in platelet-to-lymphocyte ratio during chemotherapy with survival in patients with non-small cell lung cancer
AU - Tingshan Xu
AU - Zihang Wu
AU - Jingshan Li
AU - Lingxuan Wang
AU - Baoqiang Weng
AU - Luyang Chen
AU - Xiaohui Chen
AU - Qingyuan Zhu
AU - Peng Liu
AU - Fei He
AU - Yuan Xu
PY - 2026
DA - 2026/10/02
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1934583
UR - https://europepmc.org/article/PMC/PMC13672012
AB - Background: Inflammatory markers have been reported to be associated with outcomes in non-small cell lung cancer (NSCLC). However, whether early treatment-related changes in these markers provide additional prognostic information remains unclear. This study evaluated the association between dynamic changes in peripheral blood inflammatory markers during chemotherapy and survival outcomes in patients with NSCLC. Methods: We retrospectively analyzed 479 patients with NSCLC who received chemotherapy. Changes in lymphocyte, platelet, and neutrophil counts, as well as the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (PLR), were calculated as absolute differences (D-values) between baseline measurements obtained before the first chemotherapy session and post-chemotherapy measurements obtained within 7 days after the first session. Overall survival (OS) was assessed using Kaplan–Meier analysis and Cox proportional hazards models. Additional Cox models were used to examine the association of PLR D-value with OS after accounting for baseline PLR and clinical covariates. A prognostic nomogram was constructed as an exploratory risk-estimation model. Results: Greater changes in the evaluated hematological markers were associated with shorter OS in Kaplan–Meier analysis. In the primary multivariable Cox regression, high PLR D-value was associated with shorter OS (hazard ratio, 1.422; 95% confidence interval, 1.001–2.020; P = 0.049), together with sex, anemia status, and tumor extent. After adjustment for baseline PLR and clinical covariates, however, PLR D-value was no longer significantly associated with OS when analyzed either as a continuous variable (HR per 50-unit increase, 1.010; 95% CI, 0.947–1.078; P = 0.762) or using the original high/low classification (HR, 1.31; 95% CI, 0.91–1.89; P = 0.145). The nomogram had an apparent C-index of 0.630 and an optimism-corrected C-index of 0.618 after 1,000 bootstrap resamples. Conclusions: Greater changes in PLR during chemotherapy were associated with shorter OS in the primary categorical analysis. However, this association was attenuated after baseline PLR and clinical factors were taken into account, indicating that the additional prognostic contribution of PLR D-value may be limited. The nomogram should be considered exploratory and requires external validation before clinical application.
SN - 2234-943X
ER -